Like HMOs, MCOs agree to provide Medicaid benefits to people in exchange for monthly payments from the state. In 2013, researchers from Georgetown University’s Health Policy Institute conducted interviews with healthcare providers and care coordinators serving Medicaid patients in four communities — Milwaukee, Wis.; Oakland, Calif.; Seattle; and Washington, D.C. — to gauge the effect MCOs have had on service delivery. Overall, the researchers found providers don’t view MCOs as driving improvements in care delivery for Medicaid beneficiaries.
“Managed care brings some certainty about program spending, but not necessarily certainty that quality will improve unless there are other factors, unless MCOs engage in specific initiatives,” says study co-author Laura Summer, MPH, a senior research scholar at the Health Policy Institute at Georgetown University in Washington, D.C.
Based on feedback from providers in the studied communities, the researchers identified the following five practices MCOs could implement or expand upon to improve care effectiveness and efficiency.
1. MCOs could look into methods for reimbursing providers for services like group or home visits, which providers identified as beneficial for patients with complex conditions.
2. MCOs could encourage patient-centered care through reimbursement for more types of nonphysician professionals, such as patient navigators, and payment for supportive services such as transportation and child care for patients.
3. Managed care plans could also contract with local organizations that beneficiaries already trust to develop care management programs that involve frequent, in-person contact with patients.
4. MCOs should regularly provide hospital visit encounter data to primary care providers to drive the appropriate use of emergency departments and improve post-hospital transitions.
5. Primary care providers and referral specialists would like MCOs to provide them with accurate and current lists of network specialists who accept referrals.
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